CLINICAL RESEARCH: CARDIAC SURGERY
Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity
Meta-Analysis of Randomized and Observational Studies
Duminda N. Wijeysundera, MD*,*,
W. Scott Beattie, MD, PhD*,
George Djaiani, MD*,
Vivek Rao, MD, PhD ,
Michael A. Borger, MD, PhD,
Keyvan Karkouti, MD, MSc*, and
Robert J. Cusimano, MD
* Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Manuscript received February 22, 2005;
revised manuscript received May 15, 2005,
accepted May 31, 2005.
* Reprint requests and correspondence: Dr. Duminda N. Wijeysundera, EN 3-450, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. (Email: duminda.wijeysundera{at}uhn.on.ca).
 |
Abstract
|
|---|
OBJECTIVES: The purpose of this study was to assess the effects of off-pump coronary bypass surgery (OPCAB) on mortality and morbidity.
BACKGROUND: Despite its potential for reducing morbidity and mortality, OPCAB’s role in clinical practice remains controversial.
METHODS: A meta-analysis of 37 randomized controlled trials (RCTs) (n=3,449) and 22 risk-adjusted (logistic regression or propensity-score) observational studies (n=293,617) was performed. Two reviewers performed literature searches (MEDLINE, EMBASE, PubMed, reference lists), quality assessment, and data extraction. Treatment effects were calculated as odds ratios (ORs) with 95% confidence intervals (CIs).
RESULTS: In RCTs, OPCAB was associated with reduced atrial fibrillation (OR 0.59; 95% CI 0.46 to 0.77) and trends toward reduced 30-day mortality (OR 0.91 95% CI 0.45 to 1.83), stroke (OR 0.52; 95% CI 0.25 to 1.05), and myocardial infarction (OR 0.79; 95% CI 0.50 to 1.25). Observational studies showed OPCAB to be associated with reduced 30-day mortality (OR 0.72; 95% CI 0.66 to 0.78), stroke (OR 0.62; 95% CI 0.55 to 0.69), infarction (OR 0.66; 95% CI 0.50 to 0.88), and atrial fibrillation (OR 0.78; 95% CI 0.74 to 0.82). At one to two years, OPCAB was associated with trends toward reduced mortality, but also increased repeat revascularization (RCT: OR 1.75, 95% CI 0.78 to 3.94; Observational: OR 1.35, 95% CI 0.76 to 2.39).
CONCLUSIONS: Randomized controlled trials did not find, aside from atrial fibrillation, the statistically significant reductions in short-term mortality and morbidity demonstrated by observational studies. These discrepancies might be due to differing patient-selection and study methodology. Future studies must focus on improving research methodology, recruiting high-risk patients, and collecting long-term data.
|
Abbreviations and Acronyms
| | CCAB = conventional coronary artery bypass surgery | | CI = confidence interval | | CPB = cardiopulmonary bypass | | OPCAB = off-pump coronary artery bypass surgery | | OR = odds ratio | | RCT = randomized controlled trial |
|
Conventional coronary artery bypass surgery (CCAB) is associated with mortality and morbidity (1). Components that might contribute to these adverse events include cardiopulmonary bypass (CPB) and aortic cross-clamping. Although CPB allows for construction of anastomoses in a bloodless and motionless surgical field, it generates a systemic inflammatory response and microemboli (2). Furthermore, cross-clamping of the aorta leads to atheromatous macroembolization, which is associated with adverse outcomes (3).
Increased awareness of CCAB’s adverse effects has renewed interest in off-pump coronary artery bypass surgery (OPCAB). In OPCAB, anastomoses are performed on a beating heart without CPB, thereby avoiding the latter’s inherent risks. In particular, OPCAB might prevent adverse cerebral events. Off-pump coronary artery bypass surgery, however, carries its own risks: intraoperative hemodynamic instability and inadequate revascularization (4). Given the paucity of large randomized trials showing OPCAB to cause significant effects on important outcomes, OPCAB’s role in clinical practice remains controversial (5).
Therefore, we performed a systematic review to address this uncertainty about OPCAB’s benefits. This review focused on randomized controlled trials (RCTs) and observational studies that statistically adjusted for differences between patients who underwent OPCAB as opposed to CCAB.
Our study had four objectives: to estimate OPCAB’s effects within RCTs and observational studies; to describe differences between the study types with regard to treatment effects; to identify deficiencies in published reports; and to make suggestions about the design of future studies.
|
Methods
|
|---|
This review adhered to the QUOROM recommendations (6).
Search strategy.
Two reviewers searched MEDLINE (1966 to June 2004), EMBASE (1980 to June 2004), and PubMed (up to June 30, 2004) for RCTs comparing OPCAB against CCAB. The text words employed were off-pump, beating heart, OPCAB, OPCABG, MIDCAB, MIDCABG, without extra-corporeal circulation, and without cardiopulmonary bypass. Included trials had to report any of the following outcomes: death, stroke, myocardial infarction, atrial fibrillation, or acute renal failure.
The same reviewers searched MEDLINE, EMBASE, and PubMed for observational studies reporting risk-adjusted effects of OPCAB on any of the same outcomes. Acceptable risk-adjustment methods included multivariable logistic regression or propensity score techniques. The text words and Medical Subject Headings employed were off-pump, beating heart, OPCAB, OPCABG, MIDCAB, MIDCABG, without extra-corporeal circulation, without cardiopulmonary bypass, logistic models (explode), multivariate analysis (explode), risk adjustment (explode), regression analysis (explode), multivariable, multivariate, multiple logistic, adjust$, and propensity. Bibliographies of included articles were also searched. No language restrictions were applied.
We employed several strategies to avoid duplicate publications. If the same institution produced multiple studies, we only considered studies reporting recruitment time periods. If there was sample overlap between studies, we included only the largest study. In the case of observational studies, the possibility of including overlapping patients exists when centers analyze their own data and also contribute them to national databases. We assessed the influence of such duplicate reporting by analyzing results from small (<10 centers) and large ( 10 centers) databases separately.
Quality assessment and data abstraction.
Two reviewers performed quality assessment and data abstraction. Randomized controlled trial quality was rated with regard to randomization, allocation concealment, blinded outcome assessment, and dropouts. Risk-adjusted observational studies were evaluated on the basis of suggested criteria (7).
Data were abstracted on death, stroke, infarction, atrial fibrillation, acute renal failure, inotropic support, low output syndrome, red cell transfusion, re-operation for bleeding, repeat revascularization (one year), and bypass graft number. We accepted the outcome definitions used by the original researchers. All disagreements were resolved by consensus.
Analyses.
We employed Review Manager 4.2.7 (Cochrane Collaboration, Oxford, United Kingdom) to combine treatment effects among studies with the same design. All analyses were performed on an intention-to-treat basis. Effects on dichotomous outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). For observational studies, adjusted ORs were logarithmically transformed and combined with the weighted inverse variance method. Continuous outcomes were expressed as weighted mean differences with 95% CIs. Heterogeneity was assessed with the Q-statistic. In the absence of significant heterogeneity, treatment effects were pooled with the fixed-effects model. If there was significant heterogeneity (p  0.1), the random-effects model was used; in addition, we performed post-hoc analyses to explain the heterogeneity. Statistical significance was defined by p 0.05.
Sensitivity analyses.
The sensitivity analyses assessed the influence of included studies and statistical models. The first analysis assessed the influence of study quality. In the case of RCTs, meta-analyses were repeated among studies reporting allocation concealment. Meta-analyses were also repeated among high-quality observational studies that employed prospective data, reported ORs with CIs, specified variables that were considered for inclusion, described the variable selection process, and had 10 outcome events per predictor variable. The second analysis examined the influence of the statistical model. Analyses that employed the fixed-effects model were repeated with the random-effects model.
|
Results
|
|---|
The search yielded fifty-nine studies (Fig. 1). Thirty-seven RCTs (3,449 patients) were included (Table 1) (8–43). A single paper reported the results of two trials, which were analyzed separately (9). The short- and mid-term outcomes of two other RCTs were reported in separate publications (32,37,44,45).
View this table:
[in this window]
[in a new window]
|
Table 1. Characteristics of Included Randomized Controlled Trials That Assessed Off-Pump Coronary Artery Bypass Surgery (OPCAB)
|
|
Twenty-two observational studies (293,617 patients) were included (Table 2) (46–67). The short- and mid-term outcomes of the same sample were reported in separate publications (63,64). In the case of two other cohorts, OPCAB’s association with different outcomes was reported in separate publications (51,52,61,66). The quality of multivariable modeling was variable (Table 3).
Short-term outcomes.
Ten RCTs reported 1 death within 30 days of surgery, with an incidence of 1.7% (n=29) (Table 4) (9,12,13,16,24–26,29,32,35). Off-pump coronary artery bypass surgery was associated with essentially no change in mortality (OR 0.91; 95% CI 0.45 to 1.83). Fourteen observational studies reported adjusted effects on short-term mortality (46,47,49,50,53–55,57,59–63,65). These studies showed that OPCAB was associated with significantly reduced short-term mortality (OR 0.72; 95% CI 0.66 to 0.78).
The number of RCTs reporting 1 stroke was 12, with an incidence of 1.3% (n=27) (9,12,24–26,28,29,32,33,35,37). Off-pump coronary artery bypass surgery was associated with a reduction in stroke that bordered on statistical significance (OR 0.51; 95% CI 0.25 to 1.05). In the fifteen observational studies reporting risk-adjusted effects on stroke, OPCAB was associated with a significant reduction in stroke (OR 0.62; 95% CI 0.55 to 0.69) (47,48,50,51,53–61,63,65).
Nineteen RCTs reported 1 infarction, with an incidence of 2.7% (n=70) (8–10,12,16,18,21,22,25,29,31–35,37,41,42). Off-pump coronary artery bypass surgery non-significantly reduced infarction (OR 0.79; 95% CI 0.50 to 1.25). The number of observational studies reporting risk-adjusted effects on infarction was six (49,53,55,59,61,63). These studies showed OPCAB to be associated with significantly reduced infarction rates (OR 0.66; 95% CI 0.50 to 0.88).
The number of RCTs reporting 1 episode of atrial fibrillation was 18, with an incidence of 22% (n=557) (8,9,14,16,20,22,24–26,29,31,32,35,37,38,40,43). Off-pump coronary artery bypass surgery caused a significant reduction in atrial fibrillation (OR 0.59; 95% CI 0.46 to 0.77), albeit with significant heterogeneity (p=0.09). This heterogeneity was explained by stratification, according to atrial fibrillation rates in the control arms (Table 5). Stratification also suggested that effects on atrial fibrillation varied with the baseline incidence of the arrhythmia. In the four observational studies reporting risk-adjusted effects on atrial fibrillation, OPCAB was associated with a statistically significant reduction in atrial fibrillation (OR 0.78; 95% CI 0.74 to 0.82) (53,57,59,67).
Off-pump coronary artery bypass surgery was also associated with favorable effects on other postoperative morbid events (Table 4). The only other statistically significant benefits that were demonstrated in RCTs were reduced inotrope requirements and red cell transfusion. As with atrial fibrillation, stratification suggested that OPCAB’s effect on inotropic support varied with the baseline incidence of inotrope use (Table 5).
Long-term outcomes.
Five RCTs reported 1 long-term (one to two years) mortality (Table 4) (9,29,44,45). Off-pump coronary artery bypass surgery was associated with trends toward reduced long-term mortality (OR 0.82; 95% CI 0.40 to 1.68) and infarction (OR 0.61; 95% CI 0.32 to 1.18). These improvements were, however, associated with a non-significantly increased need for repeat revascularization (OR 1.75; 95% CI 0.78 to 3.94). The two observational studies reporting risk-adjusted effects on long-term outcomes showed essentially no change in mortality (OR 1.01; 95% CI 0.74 to 1.40), non-significantly reduced infarction (OR 0.91; 95% CI 0.55 to 1.49), and trends toward increased repeat revascularization (OR 1.35; 95% CI 0.76 to 2.39) (53,64).
Adequacy of revascularization.
Twenty-four RCTs (2,284 individuals) reported the mean number of bypass grafts (8–11,14–16,20,21,24–30,32–34,36–38,40,43). Despite random allocation to OPCAB or CCAB, the mean graft number was 0.19 lower in the OPCAB arm. This difference was statistically significant (95% CI: 0.25 lower to 0.13 lower; p < 0.00001), without statistically significant heterogeneity (p=0.15).
Sensitivity analyses.
Treatment effects were generally not affected by study quality or statistical model (Table 6). Effects on mortality (OR 0.76; 95% CI 0.69 to 0.83) and stroke (OR 0.66; 95% CI 0.57 to 0.75) in large databases were similar to smaller datasets (mortality: OR 0.63, 95% CI 0.54 to 0.74; stroke: OR 0.54, 95% CI 0.46 to 0.66) (47,50,60).
|
Discussion
|
|---|
Treatment effects associated with OPCAB are generally more favorable in observational studies than in RCTs. The magnitude of OPCAB’s effects in observational studies exceeded that in RCTs for important short-term outcomes: mortality, infarction, low-output syndrome, re-operation, and acute renal failure. Observational studies showed OPCAB to have statistically significant effects on short-term outcomes, aside from re-operation for bleeding. In contrast, RCTs demonstrated statistically significant benefits for only two outcomes (atrial fibrillation, red cell transfusion).
Importantly, RCTs did not show OPCAB to reduce mortality; even the observed trend was not impressive. All-cause mortality is an important outcome: as a "hard" outcome, it was less sensitive to the absence of blinded outcome assessment in most RCTs. Although the trend toward reduced stroke in RCTs is promising, this potential must be tempered by the general absence of blinded outcome adjudication and standardized stroke assessment protocols.
In contrast, OPCAB’s mortality benefit in observational studies was statistically significant and 20% greater in magnitude. All-cause mortality is likely the most robust outcome in observational studies, given that these studies lacked blinded outcome assessment and systematic outcome surveillance. There are several possible reasons for this discrepancy between RCTs and observational studies. First, statistical significance in observational studies is driven by the much larger sample size. Second, risk-adjustment techniques might have failed to adequately adjust for the differences between patients who underwent OPCAB as opposed to CCAB. Third, up to 13% of attempted OPCAB procedures are converted intraoperatively to CCAB (68). Given that urgent conversion is associated with mortality and morbidity, OPCAB’s benefits might be exaggerated if converted procedures were coded as CCAB in clinical registries (68). Finally, mortality benefits seen in RCTs might have been diminished because most recruited individuals were low-risk. The 1.7% mortality rate reported in the CCAB arms of RCTs is approximately one-half the average North American rate (1). As suggested by OPCAB’s effects on atrial fibrillation and inotrope requirement, its effect on mortality might be enhanced among higher-risk patients.
Both RCTs and observational studies raise important questions about OPCAB’s long-term effects. Both study types demonstrated that OPCAB was associated with trends toward increased repeat revascularization. In the context of significantly fewer grafts with OPCAB, future studies must address the frequency of repeat revascularization with OPCAB. This end point is likely more relevant to patients than assessments of graft patency.
Several previous systematic reviews have addressed OPCAB outcomes (54,69–74). Most focused only on RCTs or specific outcomes (69–72,74). Except for Cheng et al. (75), our study included more RCTs than did previous reviews. Reston et al. (73) was the only previous study to consider data from RCTs and observational studies for several outcomes; however, observational studies were not restricted to risk-adjusted ones. Although Reston et al. (73) suggest that including non-adjusted studies did not exaggerate OPCAB’s benefits, our results suggest otherwise. Their estimated effect on short-term mortality (OR 0.64; 95% CI 0.54 to 0.75) is larger than our estimate for both RCTs (OR 0.91) and observational studies (OR 0.72).
This review identifies important deficiencies in the literature that must be addressed by future RCTs. Trials remain underpowered to detect clinically important treatment effects. Assuming a 2% baseline stroke rate, approximately 5,000 patients would be required to detect the effect suggested by our study (alpha 0.05, power 80%) (60). In addition, patients enrolled in trials thus far were generally low-risk. This patient profile reduces the generalizability of the results, necessitates larger sample sizes, and might underestimate OPCAB’s benefits among higher-risk patients. Further improvements remain needed in the quality of RCTs. Most previous trials did not adequately conceal allocation or blind outcome assessors, both of which can influence estimated treatment efficacy (76). Blinding of outcome assessors is also integral to confirming our finding that OPCAB might prevent non-fatal morbid events (stroke, atrial fibrillation, inotropic support). Finally, more RCTs must address longer-term outcomes. The importance of these data cannot be overstated.
In the absence of large RCTs, risk-adjusted observational studies constitute the majority of the evidence supporting OPCAB’s benefits. Observational research within cardiac surgery has been facilitated by prospective databases with rigorous quality control and follow-up. Observational research has important advantages. The results might be more generalizable: patients and surgeons included in observational studies are more similar to those encountered in clinical practice. Randomized controlled trials generally recruit low-risk patients who undergo surgery performed by a few experienced surgeons. Given that most perioperative adverse events are uncommon, adequately powered RCTs remain large and expensive. Observational studies are a more economical method for evaluating OPCAB’s effectiveness.
These advantages, however, are counter-balanced by important limitations. Unmeasured confounders might bias even well-analyzed cohort studies; therefore, meta-analyses of observational data might produce precise but spurious results (77). In addition, interpretation of results from observational studies should be limited to associations; no causal inferences should be drawn. Despite these limitations, there remains a role for observational research in establishing the effectiveness of OPCAB. Future studies must report more transparent analytic plans, account for misclassification of converted OPCAB procedures, and incorporate longer-term outcomes.
Conclusions.
Randomized controlled trials did not find, aside from atrial fibrillation, the significant reductions in short-term mortality and morbidity demonstrated by observational studies. These discrepancies are explained, in part, by differing patient selection and study methodology. This review identifies three important goals for future studies. First, research methodology must be improved to clarify OPCAB’s potential for preventing non-fatal morbid events. Second, long-term data are required to understand OPCAB’s association with repeat revascularization. Finally, as opposed to recruiting low-risk individuals, studies should focus on patients at increased risk for perioperative morbid events.
|
Footnotes
|
|---|
Drs. Wijeysundera, Rao, and Karkouti are supported in part by the Canadian Institutes of Health Research.
|
References
|
|---|
1. Shroyer AL, Coombs LP, Peterson ED, et al. The Society of Thoracic Surgeons30-day operative mortality and morbidity risk models. Ann Thorac Surg 2003;75:1856-1864.[Abstract/Free Full Text]
2. Bruins P, te Velthuis H, Yazdanbakhsh AP, et al. Activation of the complement system during and after cardiopulmonary bypass surgerypostsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 1997;96:3542-3548.[Abstract/Free Full Text]
3. Barbut D, Lo YW, Gold JP, et al. Impact of embolization during coronary artery bypass grafting on outcome and length of stay Ann Thorac Surg 1997;63:998-1002.[Abstract/Free Full Text]
4. Ascione R, Angelini GD. Off-pump coronary artery bypass surgerythe implications of the evidence. J Thorac Cardiovasc Surg 2003;125:779-781.[Free Full Text]
5. Bonchek LI. Off-pump coronary bypassis it for everyone?. J Thorac Cardiovasc Surg 2002;124:431-434.[Free Full Text]
6. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses Lancet 1999;354:1896-1900.[CrossRef][Web of Science][Medline]
7. Moss M, Wellman DA, Cotsonis GA. An appraisal of multivariable logistic models in the pulmonary and critical care literature Chest 2003;123:923-928.[Abstract/Free Full Text]
8. Alwan K, Falcoz PE, Alwan J, et al. Beating versus arrested heart coronary revascularizationevaluation by cardiac troponin I release. Ann Thorac Surg 2004;77:2051-2055.[Abstract/Free Full Text]
9. Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2)a pooled analysis of two randomised controlled trials. Lancet 2002;359:1194-1199.[CrossRef][Web of Science][Medline]
10. Baker RA, Andrew MJ, Ross IK, Knight JL. The Octopus II stabilizing systembiochemical and neuropsychological outcomes in coronary artery bypass surgery. Heart Surg Forum 2001;4(Suppl 1):19-23.
11. Caputo M, Yeatman M, Narayan P, et al. Effect of off-pump coronary surgery with right ventricular assist device on organ function and inflammatory responsea randomized controlled trial. Ann Thorac Surg 2002;74:2088-2095.[Abstract/Free Full Text]
12. Carrier M, Perrault LP, Jeanmart H, Martineau R, Cartier R, Page P. Randomized trial comparing off-pump to on-pump coronary artery bypass grafting in high-risk patients Heart Surg Forum 2003;6:E89-E92.[Web of Science][Medline]
13. Covino E, Santise G, Di Lello F, et al. Surgical myocardial revascularization (CABG) in patients with pulmonary diseasebeating heart versus cardiopulmonary bypass. J Cardiovasc Surg (Torino) 2001;42:23-26.[Medline]
14. Czerny M, Baumer H, Kilo J, et al. Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass Ann Thorac Surg 2001;71:165-169.[Abstract/Free Full Text]
15. Diegeler A, Hirsch R, Schneider F, et al. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation Ann Thorac Surg 2000;69:1162-1166.[Abstract/Free Full Text]
16. Gerola LR, Buffolo E, Jasbik W, et al. Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel diseaseperioperative results in a multicenter randomized controlled trial. Ann Thorac Surg 2004;77:569-573.[Abstract/Free Full Text]
17. Gu YJ, Mariani MA, van Oeveren W, Grandjean JG, Boonstra PW. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting Ann Thorac Surg 1998;65:420-424.[Abstract/Free Full Text]
18. Guler M, Kirali K, Toker ME, et al. Different CABG methods in patients with chronic obstructive pulmonary disease Ann Thorac Surg 2001;71:152-157.[Abstract/Free Full Text]
19. Gulielmos V, Eller M, Thiele S, et al. Influence of median sternotomy on the psychosomatic outcome in coronary artery single-vessel bypass grafting Eur J Cardiothorac Surg 1999;16:S34-S38.[Web of Science][Medline]
20. Johansson-Synnergren M, Nilsson F, Bengtsson A, Jeppsson A, Wiklund L. Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial functiona prospective randomized study. Scand Cardiovasc J 2004;38:53-58.[CrossRef][Web of Science][Medline]
21. Khan NE, De Souza A, Mister R, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery N Engl J Med 2004;350:21-28.[CrossRef][Web of Science][Medline]
22. Kochamba GS, Yun KL, Pfeffer TA, Sintek CF, Khonsari S. Pulmonary abnormalities after coronary arterial bypass grafting operationcardiopulmonary bypass versus mechanical stabilization. Ann Thorac Surg 2000;69:1466-1470.[Abstract/Free Full Text]
23. Krejca M, Skiba J, Szmagala P, Gburek T, Bochenek A. Cardiac troponin T release during coronary surgery using intermittent cross-clamp with fibrillation, on-pump and off-pump beating heart Eur J Cardiothorac Surg 1999;16:337-341.[Abstract/Free Full Text]
24. Lee JD, Lee SJ, Tsushima WT, et al. Benefits of off-pump bypass on neurologic and clinical morbiditya prospective randomized trial. Ann Thorac Surg 2003;76:18-25.[Abstract/Free Full Text]
25. Legare JF, Buth KJ, King S, et al. Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump Circulation 2004;109:887-892.[Abstract/Free Full Text]
26. Lingaas PS, Hol PK, Lundblad R, et al. Clinical and angiographic outcome of coronary surgery with and without cardiopulmonary bypassa prospective randomized trial. Heart Surg Forum 2004;7:37-41.[Medline]
27. Matata BM, Sosnowski AW, Galinanes M. Off-pump bypass graft operation significantly reduces oxidative stress and inflammation Ann Thorac Surg 2000;69:785-791.[Abstract/Free Full Text]
28. Motallebzadeh R, Kanagasabay R, Bland M, Kaski JC, Jahangiri M. S100 protein and its relation to cerebral microemboli in on-pump and off-pump coronary artery bypass surgery Eur J Cardiothorac Surg 2004;25:409-414.[Abstract/Free Full Text]
29. Muneretto C, Bisleri G, Negri A, et al. Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularizationa prospective randomized study. Ann Thorac Surg 2003;76:778-782.[Abstract/Free Full Text]
30. Parolari A, Alamanni F, Juliano G, et al. Oxygen metabolism during and after cardiac surgeryrole of CPB. Ann Thorac Surg 2003;76:737-743.[Abstract/Free Full Text]
31. Penttila HJ, Lepojarvi MVK, Kiviluoma KT, Kaukoranta PK, Hassinen IE, Peuhkurinen KJ. Myocardial preservation during coronary surgery with and without cardiopulmonary bypass Ann Thorac Surg 2001;71:565-570.[Abstract/Free Full Text]
32. Puskas JD, Williams WH, Duke PG, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stayA prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:797-808.[Abstract/Free Full Text]
33. Sahlman A, Ahonen J, Nemlander A, et al. Myocardial metabolism on off-pump surgery; a randomized study of 50 cases Scand Cardiovasc J 2003;37:211-215.[CrossRef][Web of Science][Medline]
34. Selvanayagam JB, Petersen SE, Francis JM, et al. Effects of off-pump versus on-pump coronary surgery on reversible and irreversible myocardial injurya randomized trial using cardiovascular magnetic resonance imaging and biochemical markers. Circulation 2004;109:345-350.[Abstract/Free Full Text]
35. Straka Z, Widimsky P, Jirasek K, et al. Off-pump versus on-pump coronary surgeryfinal results from a prospective randomized study PRAGUE-4. Ann Thorac Surg 2004;77:789-793.[Abstract/Free Full Text]
36. Tang ATM, Knott J, Nanson J, et al. A prospective randomized study to evaluate the renoprotective action of beating heart coronary surgery in low risk patients Eur J Cardiothorac Surg 2002;22:118-123.[Abstract/Free Full Text]
37. van Dijk D, Nierich AP, Jansen EW, et al. Early outcome after off-pump versus on-pump coronary bypass surgeryresults from a randomized study. Circulation 2001;104:1761-1766.[Abstract/Free Full Text]
38. Velissaris T, Tang A, Murray M, El Minshawy A, Hett D, Ohri S. A prospective randomized study to evaluate splanchnic hypoxia during beating-heart and conventional coronary revascularization Eur J Cardiothorac Surg 2003;23:917-924.[Abstract/Free Full Text]
39. Vural KM, Tasdemir O, Karagoz H, Emir M, Tarcan O, Bayazit K. Comparison of the early results of coronary artery bypass grafting with and without extracorporeal circulation Thorac Cardiovasc Surg 1995;43:320-325.[Web of Science][Medline]
40. Wan IY, Arifi AA, Wan S, et al. Beating heart revascularization with or without cardiopulmonary bypassevaluation of inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg 2004;127:1624-1631.[Abstract/Free Full Text]
41. Wandschneider W, Thalmann M, Trampitsch E, Ziervogel G, Kobinia G. Off-pump coronary bypass operations significantly reduce S100 releasean indicator for less cerebral damage?. Ann Thorac Surg 2000;70:1577-1579.[Abstract/Free Full Text]
42. Wehlin L, Vedin J, Vaage J, Lundahl J. Activation of complement and leukocyte receptors during on- and off-pump coronary artery bypass surgery Eur J Cardiothorac Surg 2004;25:35-42.[Abstract/Free Full Text]
43. Zamvar V, Williams D, Hall J, et al. Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgeryprospective randomised controlled trial. BMJ 2002;325:1268-1272.[Abstract/Free Full Text]
44. Nathoe HM, van Dijk D, Jansen EW, et al. A comparison of on-pump and off-pump coronary bypass surgery in low-risk patients N Engl J Med 2003;348:394-402.[CrossRef][Web of Science][Medline]
45. Puskas JD, Williams WH, Mahoney EM, et al. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial JAMA 2004;291:1841-1849.[Abstract/Free Full Text]
46. Al Ruzzeh S, Athanasiou T, George S, et al. Is the use of cardiopulmonary bypass for multivessel coronary artery bypass surgery an independent predictor of operative mortality in patients with ischemic left ventricular dysfunction? Ann Thorac Surg 2003;76:444-451.[Abstract/Free Full Text]
47. Aldea GS, Goss JR, Boyle Jr EM, Quinton RR, Maynard C. Use of off-pump and on-pump CABG strategies in current clinical practicethe Clinical Outcomes Assessment Program of the state of Washington. J Card Surg 2003;18:206-215.[CrossRef][Web of Science][Medline]
48. Ascione R, Reeves BC, Chamberlain MH, Ghosh AK, Lim KH, Angelini GD. Predictors of stroke in the modern era of coronary artery bypass graftinga case control study. Ann Thorac Surg 2002;74:474-480.[Abstract/Free Full Text]
49. Boening A, Friedrich C, Hedderich J, Schoettler J, Fraund S, Cremer JT. Early and medium-term results after on-pump and off-pump coronary artery surgerya propensity score analysis. Ann Thorac Surg 2003;76:2000-2006.[Abstract/Free Full Text]
50. Brown PP, Mack MJ, Simon AW, et al. Outcomes experience with off-pump coronary artery bypass surgery in women Ann Thorac Surg 2002;74:2113-2119.[Abstract/Free Full Text]
51. Bucerius J, Gummert JF, Borger MA, et al. Stroke after cardiac surgerya risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 2003;75:472-478.[Abstract/Free Full Text]
52. Bucerius J, Gummert JF, Walther T, et al. On-pump versus off-pump coronary artery bypass graftingimpact on postoperative renal failure requiring renal replacement therapy. Ann Thorac Surg 2004;77:1250-1256.[Abstract/Free Full Text]
53. Calafiore AM, Di Mauro M, Contini M, et al. Myocardial revascularization with and without cardiopulmonary bypass in multivessel diseaseimpact of the strategy on early outcome. Ann Thorac Surg 2001;72:456-462.[Abstract/Free Full Text]
54. Cheng W, Denton TA, Fontana GP, et al. Off-pump coronary surgeryeffect on early mortality and stroke. J Thorac Cardiovasc Surg 2002;124:313-320.[Abstract/Free Full Text]
55. Gaudino M, Glieca F, Alessandrini F, et al. High risk coronary artery bypass patientincidence, surgical strategies, and results. Ann Thorac Surg 2004;77:574-579.[Abstract/Free Full Text]
56. Grunkemeier GL, Payne N, Jin R, Handy JR. Propensity score analysis of stroke after off-pump coronary artery bypass grafting Ann Thorac Surg 2002;74:301-305.[Free Full Text]
57. Hernandez F, Cohn WE, Baribeau YR, et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass proceduresa multicenter experience. Ann Thorac Surg 2001;72:1528-1533.[Abstract/Free Full Text]
58. Hirose H, Amano A, Takahashi A. Side clamp used during off-pump coronary artery bypass does not increase the risk of stroke Med Sci Monit 2002;8:235-240.
59. Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease J Thorac Cardiovasc Surg 2004;127:167-173.[Abstract/Free Full Text]
60. Magee MJ, Coombs LP, Peterson ED, Mack MJ. Patient selection and current practice strategy for off-pump coronary artery bypass surgery Circulation 2003;108(Suppl 1):II9-II14.
61. Patel NC, Grayson AD, Jackson M, et al. The effect off-pump coronary artery bypass surgery on in-hospital mortality and morbidity Eur J Cardiothorac Surg 2002;22:255-260.[Abstract/Free Full Text]
62. Plomondon ME, Cleveland JC, Ludwig ST, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes Ann Thorac Surg 2001;72:114-119.[Abstract/Free Full Text]
63. Sabik JF, Gillinov AM, Blackstone EH, et al. Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 2002;124:698-707.[Abstract/Free Full Text]
64. Sabik JF, Blackstone EH, Lytle BW, Houghtaling PL, Gillinov AM, Cosgrove DM. Equivalent midterm outcomes after off-pump and on-pump coronary surgery J Thorac Cardiovasc Surg 2004;127:142-148.[Abstract/Free Full Text]
65. Sharony R, Grossi EA, Saunders PC, et al. Propensity case-matched analysis of off-pump coronary artery bypass grafting in patients with atheromatous aortic disease J Thorac Cardiovasc Surg 2004;127:406-413.[Abstract/Free Full Text]
66. Stallwood MI, Grayson AD, Mills K, Scawn ND. Acute renal failure in coronary artery bypass surgeryindependent effect of cardiopulmonary bypass. Ann Thorac Surg 2004;77:968-972.[Abstract/Free Full Text]
67. Tamis-Holland JE, Homel P, Durani M, et al. Atrial fibrillation after minimally invasive direct coronary artery bypass surgery J Am Coll Cardiol 2000;36:1884-1888.[Abstract/Free Full Text]
68. Legare JF, Buth KJ, Hirsch GM. Conversion to on pump from OPCAB is associated with increased mortalityresults from a randomized controlled trial. Eur J Cardiothorac Surg 2005;27:296-301.[Abstract/Free Full Text]
69. Athanasiou T, Aziz O, Mangoush O, et al. Do off-pump techniques reduce the incidence of postoperative atrial fibrillation in elderly patients undergoing coronary artery bypass grafting? Ann Thorac Surg 2004;77:1567-1574.[Abstract/Free Full Text]
70. Athanasiou T, Al Ruzzeh S, Kumar P, et al. Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients Ann Thorac Surg 2004;77:745-753.[Abstract/Free Full Text]
71. Athanasiou T, Aziz O, Mangoush O, et al. Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited Eur J Cardiothorac Surg 2004;26:701-710.[Abstract/Free Full Text]
72. Parolari A, Alamanni F, Cannata A, et al. Off-pump versus on-pump coronary artery bypassmeta-analysis of currently available randomized trials. Ann Thorac Surg 2003;76:37-40.[Abstract/Free Full Text]
73. Reston JT, Tregear SJ, Turkelson CM. Meta-analysis of short-term and mid-term outcomes following off-pump coronary artery bypass grafting Ann Thorac Surg 2003;76:1510-1515.[Abstract/Free Full Text]
74. Van Der Heijden GJ, Nathoe HM, Jansen EW, Grobbee DE. Meta-analysis on the effect of off-pump coronary bypass surgery Eur J Cardiothorac Surg 2004;26:81-84.[Abstract/Free Full Text]
75. Cheng DC, Bainbridge D, Martin JE, Novick RJ. Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials Anesthesiology 2005;102:188-203.[CrossRef][Web of Science][Medline]
76. Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 1998;352:609-613.[CrossRef][Web of Science][Medline]
77. Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies BMJ 1998;316:140-144.[Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
D. Mukherjee, H. Ashrafian, A. Kourliouros, K. Ahmed, A. Darzi, and T. Athanasiou
Intra-operative conversion is a cause of masked mortality in off-pump coronary artery bypass: a meta-analysis
Eur J Cardiothorac Surg,
February 1, 2012;
41(2):
291 - 299.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Yanagawa, K. D. Algarni, T. M. Yau, V. Rao, and S. J. Brister
Improving results for coronary artery bypass graft surgery in the elderly
Eur J Cardiothorac Surg,
January 13, 2012;
(2012)
ezr300v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Wu, F. T. Camacho, A. T. Culliford, J. P. Gold, A. S. Wechsler, R. S. D. Higgins, S. J. Lahey, C. R. Smith, D. Jordan, and E. L. Hannan
A Comparison of Long-Term Mortality for Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery
Circ Cardiovasc Qual Outcomes,
January 1, 2012;
5(1):
76 - 84.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Wimmer-Greinecker, O. Bouchot, J. P. Verhoye, L. P. Perrault, J. Borgermann, A. Diegeler, L. Van Garsse, and A. J. Rastan
Randomized Clinical Trial Comparing a Thermosensitive Polymer (LeGoo) With Conventional Vessel Loops for Temporary Coronary Artery Occlusion During Off-Pump Coronary Artery Bypass Surgery
Ann. Thorac. Surg.,
December 1, 2011;
92(6):
2177 - 2183.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. N. Patel, E. Akowuah, and J. A. Hutter
Patient preference for coronary artery bypass graft surgery performed on the arrested or beating heart: a questionnaire study,
Eur J Cardiothorac Surg,
December 1, 2011;
40(6):
1282 - 1284.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Afilalo, M. Rasti, S. M. Ohayon, A. Shimony, and M. J. Eisenberg
Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials
Eur. Heart J.,
October 10, 2011;
(2011)
ehr307v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Mariscalco, R. Lorusso, C. Dominici, A. Renzulli, and A. Sala
Acute Kidney Injury: A Relevant Complication After Cardiac Surgery
Ann. Thorac. Surg.,
October 1, 2011;
92(4):
1539 - 1547.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Benedetto, G. Melina, E. Angeloni, and R. Sinatra
If we are uncritical, we shall always find what we want
J. Thorac. Cardiovasc. Surg.,
September 1, 2011;
142(3):
723 - 724.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Alston
Brain damage and cardiopulmonary bypass: is there really any association?
Perfusion,
September 1, 2011;
26(1_suppl):
20 - 26.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. Filardo, P. A. Grayburn, C. Hamilton, R. F. Hebeler Jr, W. B. Cooksey, and B. Hamman
Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations
Ann. Thorac. Surg.,
August 1, 2011;
92(2):
571 - 578.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Ben-Gal, G. W. Stone, C. R. Smith, M. R. Williams, G. Weisz, A. S. Stewart, H. Takayama, P. Genereux, and M. Argenziano
On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial
J. Thorac. Cardiovasc. Surg.,
August 1, 2011;
142(2):
e33 - e39.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Takagi, H. Manabe, and T. Umemoto
Late mortality in off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of propensity score-adjusted studies.
J. Thorac. Cardiovasc. Surg.,
August 1, 2011;
142(2):
475 - 477.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. N. Patel and G. D. Angelini
Reply to the editor.
J. Thorac. Cardiovasc. Surg.,
May 1, 2011;
141(5):
1331 - 1332.e1.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Wu, H. Sun, X. Jiang, W. Ma, X. Wang, J. Zhang, and S. Hu
Simultaneous Hybrid Revascularization by Peripheral Artery Stenting and Off-Pump Coronary Artery Bypass: The Early Results
Ann. Thorac. Surg.,
March 1, 2011;
91(3):
661 - 664.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Munos, J. Calderon, X. Pillois, S. Lafitte, A. Ouattara, L. Labrousse, X. Roques, and L. Barandon
Beating-heart coronary artery bypass surgery with the help of mini extracorporeal circulation for very high-risk patients
Perfusion,
March 1, 2011;
26(2):
123 - 131.
[Abstract]
[PDF]
|
|
|
|
|
|
|
N. N. Patel and G. D. Angelini
Off-pump coronary artery bypass grafting: For the many or the few?
J. Thorac. Cardiovasc. Surg.,
November 1, 2010;
140(5):
951 - 953.e1.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Doi and H. Yaku
Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative stroke
Eur J Cardiothorac Surg,
November 1, 2010;
38(5):
568 - 572.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F.-W. Mohr
To beat or not to beat? From one size fits it all to an individual coronary revascularization strategy
Eur. Heart J.,
October 2, 2010;
31(20):
2441 - 2443.
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Kuss, B. von Salviati, and J. Borgermann
Off-pump versus on-pump coronary artery bypass grafting: A systematic review and meta-analysis of propensity score analyses
J. Thorac. Cardiovasc. Surg.,
October 1, 2010;
140(4):
829 - 835.e13.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Edelman, T. D. Yan, R. Padang, P. G. Bannon, and M. P. Vallely
Off-Pump Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention: A Meta-Analysis of Randomized and Nonrandomized Studies
Ann. Thorac. Surg.,
October 1, 2010;
90(4):
1384 - 1390.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. F. Seabra, S. Alobaidi, E. M. Balk, A. H. Poon, and B. L. Jaber
Off-Pump Coronary Artery Bypass Surgery and Acute Kidney Injury: A Meta-Analysis of Randomized Controlled Trials
Clin. J. Am. Soc. Nephrol.,
October 1, 2010;
5(10):
1734 - 1744.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Hueb, N. H. Lopes, A. C. Pereira, A. C. Hueb, P. R. Soares, D. Favarato, R. D'Oliveira Vieira, E. G. Lima, C. L. Garzillo, F. da Silva Paulitch, et al.
Five-Year Follow-Up of a Randomized Comparison Between Off-Pump and On-Pump Stable Multivessel Coronary Artery Bypass Grafting. The MASS III Trial
Circulation,
September 14, 2010;
122(11_suppl_1):
S48 - S52.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Messina, E. Villa, Z. Mhagna, M. Dalla Tomba, M. Cirillo, F. Brunelli, E. Quaini, and G. Troise
Medium-term results of systematic off-pump coronary surgery performed by trainee surgeons
Eur J Cardiothorac Surg,
September 1, 2010;
38(3):
380 - 386.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Takagi and T. Umemoto
To pump, or not to pump, that is the question
J. Thorac. Cardiovasc. Surg.,
August 1, 2010;
140(2):
485 - 486.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Takagi, M. Matsui, and T. Umemoto
Off-Pump Coronary Artery Bypass May Increase Late Mortality: A Meta-Analysis of Randomized Trials
Ann. Thorac. Surg.,
June 1, 2010;
89(6):
1881 - 1888.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. Benedetto, E. Angeloni, and R. Sinatra
Reply to the editor.
J. Thorac. Cardiovasc. Surg.,
June 1, 2010;
139(6):
1670 - 1671.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. R. Shroff, S. Li, and C. A. Herzog
Survival of patients on dialysis having off-pump versus on-pump coronary artery bypass surgery in the United States
J. Thorac. Cardiovasc. Surg.,
May 1, 2010;
139(5):
1333 - 1338.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Hu, Z. Zheng, X. Yuan, W. Wang, Y. Song, H. Sun, and J. Xu
Increasing Long-Term Major Vascular Events and Resource Consumption in Patients Receiving Off-Pump Coronary Artery Bypass: A Single-Center Prospective Observational Study
Circulation,
April 27, 2010;
121(16):
1800 - 1808.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Sezai, M. Hata, T. Niino, I. Yoshitake, S. Unosawa, S. Wakui, S. Osaka, T. Takayama, Y. Kasamaki, A. Hirayama, et al.
Influence of Continuous Infusion of Low-Dose Human Atrial Natriuretic Peptide on Renal Function During Cardiac Surgery: A Randomized Controlled Study
J. Am. Coll. Cardiol.,
September 15, 2009;
54(12):
1058 - 1064.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Abu-Omar and D. P. Taggart
The present status of off-pump coronary artery bypass grafting
Eur J Cardiothorac Surg,
August 1, 2009;
36(2):
312 - 321.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Raja, H. Siddiqui, C. D. Ilsley, and M. Amrani
In-Hospital Outcomes of Off-Pump Multivessel Total Arterial and Conventional Coronary Artery Bypass Grafting: Single Surgeon, Single Center Experience
Ann. Thorac. Surg.,
July 1, 2009;
88(1):
47 - 52.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Nishiyama, M. Horiguchi, S. Shizuta, T. Doi, N. Ehara, R. Tanuguchi, Y. Haruna, Y. Nakagawa, Y. Furukawa, M. Fukushima, et al.
Temporal Pattern of Strokes After On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery
Ann. Thorac. Surg.,
June 1, 2009;
87(6):
1839 - 1844.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Konety, G. E. Rosenthal, and M. S. Vaughan-Sarrazin
Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?
J. Thorac. Cardiovasc. Surg.,
May 1, 2009;
137(5):
1116 - 23.e1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. D. Angelini, L. Culliford, D. K. Smith, M. C.K. Hamilton, G. J. Murphy, R. Ascione, A. Baumbach, and B. C. Reeves
Effects of on- and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: long-term follow-up of 2 randomized controlled trials.
J. Thorac. Cardiovasc. Surg.,
February 1, 2009;
137(2):
295 - 303.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Simmons
Postoperative Critical Care Management and Selected Postoperative Crises
ACCP Crit Care Med Brd Rev,
January 1, 2009;
20(0):
261 - 278.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. H. Moller, L. Penninga, J. Wetterslev, D. A. Steinbruchel, and C. Gluud
Clinical outcomes in randomized trials of off- vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses
Eur. Heart J.,
November 1, 2008;
29(21):
2601 - 2616.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Manabe, T. Shimokawa, T. Fukui, K.-u. Fumimoto, N. Ozawa, H. Seki, S. Ikenaga, and S. Takanashi
Influence of carotid artery stenosis on stroke in patients undergoing off-pump coronary artery bypass grafting
Eur J Cardiothorac Surg,
November 1, 2008;
34(5):
1005 - 1008.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. T. Webb and J. S. D. Allen
Perioperative renal protection
CEACCP,
October 1, 2008;
8(5):
176 - 180.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Barandon, P. Richebe, E. Munos, J. Calderon, M. Lafitte, S. Lafitte, T. Couffinhal, and X. Roques
Off-pump coronary artery bypass surgery in very high-risk patients: adjustment and preliminary results
Interact CardioVasc Thorac Surg,
October 1, 2008;
7(5):
789 - 793.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Cartier, O. Bouchot, and I. El-Hamamsy
Influence of sex and age on long-term survival in systematic off-pump coronary artery bypass surgery
Eur J Cardiothorac Surg,
October 1, 2008;
34(4):
826 - 832.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Li, Z. Zheng, and S. Hu
Early and long-term outcomes in the elderly: Comparison between off-pump and on-pump techniques in 1191 patients undergoing coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg.,
September 1, 2008;
136(3):
657 - 664.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Massoudy, S. Wagner, M. Thielmann, U. Herold, E. Kottenberg-Assenmacher, G. Marggraf, A. Kribben, T. Philipp, H. Jakob, and S. Herget-Rosenthal
Coronary artery bypass surgery and acute kidney injury--impact of the off-pump technique
Nephrol. Dial. Transplant.,
September 1, 2008;
23(9):
2853 - 2860.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Halkos, J. D. Puskas, O. M. Lattouf, P. Kilgo, R. A. Guyton, and V. H. Thourani
Impact of Preoperative Neurologic Events on Outcomes After Coronary Artery Bypass Grafting
Ann. Thorac. Surg.,
August 1, 2008;
86(2):
504 - 510.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Synnergren, R. Ekroth, A. Oden, H. Rexius, and L. Wiklund
Incomplete revascularization reduces survival benefit of coronary artery bypass grafting: Role of off-pump surgery
J. Thorac. Cardiovasc. Surg.,
July 1, 2008;
136(1):
29 - 36.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Alamanni, L. Dainese, M. Naliato, S. Gregu, M. Agrifoglio, G. L. Polvani, P. Biglioli, A. Parolari, and for the Monzino OPCAB Investigators
On- and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization
Eur J Cardiothorac Surg,
July 1, 2008;
34(1):
118 - 126.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. R. Untch, W. P. Jeske, J. Schwartz, S. Botkin, M. Prechel, J. M. Walenga, and M. Bakhos
Inflammatory and Hemostatic Activation in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting
Clinical and Applied Thrombosis/Hemostasis,
April 1, 2008;
14(2):
141 - 148.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. H. Rosner, D. Portilla, and M. D. Okusa
Analytic Reviews: Cardiac Surgery as a Cause of Acute Kidney Injury: Pathogenesis and Potential Therapies
J Intensive Care Med,
January 1, 2008;
23(1):
3 - 18.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. H. Yang, H.-C. Gwon, S. J. Cho, J. Y. Hahn, J.-H. Choi, S. H. Choi, Y. T. Lee, S. H. Lee, K. P. Hong, and J. E. Park
Comparison of Coronary Artery Bypass Grafting With Drug-Eluting Stent Implantation for the Treatment of Multivessel Coronary Artery Disease
Ann. Thorac. Surg.,
January 1, 2008;
85(1):
65 - 70.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. L. Brown, T. M. Sundt III, and B. J. Gersh
Indications for Revascularization
Card. Surg. Adult,
January 1, 2008;
3(2008):
551 - 572.
[Full Text]
|
|
|
|
|
|
|
J. R. Brown
Invited commentary
Ann. Thorac. Surg.,
November 1, 2007;
84(5):
1502 - 1503.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Pretorius, B. S. Donahue, C. Yu, J. P. Greelish, D. M. Roden, and N. J. Brown
Plasminogen Activator Inhibitor-1 as a Predictor of Postoperative Atrial Fibrillation After Cardiopulmonary Bypass
Circulation,
September 11, 2007;
116(11_suppl):
I-1 - I-7.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. L. Hannan, C. Wu, C. R. Smith, R. S.D. Higgins, R. E. Carlson, A. T. Culliford, J. P. Gold, and R. H. Jones
Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery: Differences in Short-Term Outcomes and in Long-Term Mortality and Need for Subsequent Revascularization
Circulation,
September 4, 2007;
116(10):
1145 - 1152.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Hosokawa, Y. Nakajima, T. Umenai, H. Ueno, S. Taniguchi, T. Matsukawa, and T. Mizobe
Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery
Br. J. Anaesth.,
May 1, 2007;
98(5):
575 - 580.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al.
Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline
Ann. Thorac. Surg.,
May 1, 2007;
83(5_Supplement):
S27 - S86.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Palmer, M. A. Herbert, S. L. Prince, J. L. Williams, M. J. Magee, P. Brown, M. Katz, and M. J. Mack
Coronary Artery Revascularization (CARE) Registry: An Observational Study of On-Pump and Off-Pump Coronary Artery Revascularization
Ann. Thorac. Surg.,
March 1, 2007;
83(3):
986 - 992.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Novitzky, A L. Shroyer, J. F Collins, G. O McDonald, J. Lucke, B. Hattler, E. Kozora, D. D Bradham, J. Baltz, F. L Grover, et al.
A study design to assess the safety and efficacy of on-pump versus off-pump coronary bypass grafting: the ROOBY trial
Clinical Trials,
February 1, 2007;
4(1):
81 - 91.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. Biancari, M. Mosorin, E. Rasinaho, J. Lahtinen, J. Heikkinen, E. Niemela, V. Anttila, M. Lepojarvi, and T. Juvonen
Postoperative stroke after off-pump versus on-pump coronary artery bypass surgery
J. Thorac. Cardiovasc. Surg.,
January 1, 2007;
133(1):
169 - 173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Lim, A. Drain, W. Davies, L. Edmonds, and B. R. Rosengard
A systematic review of randomized trials comparing revascularization rate and graft patency of off-pump and conventional coronary surgery
J. Thorac. Cardiovasc. Surg.,
December 1, 2006;
132(6):
1409 - 1413.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S S Panesar, T Athanasiou, S Nair, C Rao, C Jones, M Nicolaou, and A Darzi
Early outcomes in the elderly: a meta-analysis of 4921 patients undergoing coronary artery bypass grafting--comparison between off-pump and on-pump techniques
Heart,
December 1, 2006;
92(12):
1808 - 1816.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. J. Ferreira-Gonzalez, A. Ribera, P. Cascant, G. Permanyer-Miralda, and for the ARCA study group
Outcomes in off-pump vs. on-pump coronary artery bypass grafting stratified by pre-operative risk profile: an assessment using propensity score
Eur. Heart J.,
October 2, 2006;
27(20):
2473 - 2480.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Ben Ari, E. Elinav, A. Elami, and I. Matot
Off-pump coronary artery bypass grafting in a patient with Child class C liver cirrhosis awaiting liver transplantation
Br. J. Anaesth.,
October 1, 2006;
97(4):
468 - 472.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T.L. Ong and P. W. Serruys
Complete Revascularization: Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention
Circulation,
July 18, 2006;
114(3):
249 - 255.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Rastan, J. I. Eckenstein, B. Hentschel, A. K. Funkat, J. F. Gummert, N. Doll, T. Walther, V. Falk, and F. W. Mohr
Emergency Coronary Artery Bypass Graft Surgery for Acute Coronary Syndrome: Beating Heart Versus Conventional Cardioplegic Cardiac Arrest Strategies
Circulation,
July 4, 2006;
114(1_suppl):
I-477 - I-485.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Al-Ruzzeh, S. George, M. Bustami, J. Wray, C. Ilsley, T. Athanasiou, and M. Amrani
Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial
BMJ,
June 10, 2006;
332(7554):
1365.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. N. Djaiani
Aortic arch atheroma: stroke reduction in cardiac surgical patients.
Seminars in Cardiothoracic and Vascular Anesthesia,
June 1, 2006;
10(2):
143 - 157.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. H. Jones
The Year in Cardiovascular Surgery
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
2094 - 2107.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. Kappetein, K. D. Dawkins, F. W. Mohr, M. C. Morice, M. J. Mack, M. E. Russell, J. Pomar, and P. W. J. C. Serruys
Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease.: Insights from the SYNTAX run-in phase
Eur J Cardiothorac Surg,
April 1, 2006;
29(4):
486 - 491.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Weerasinghe, T. Athanasiou, P. Philippidis, J. Day, K. Mandal, O. Warren, J. Anderson, and K. Taylor
Platelet-monocyte pro-coagulant interactions in on-pump coronary surgery
Eur J Cardiothorac Surg,
March 1, 2006;
29(3):
312 - 318.
[Full Text]
[PDF]
|
|
|
|
Top
Abstract
Methods